Abnormal Uterine Bleeding (AUB) is a prevalent gynecological concern that significantly impacts the physical, emotional and social well-being of women of reproductive age. Defined as any deviation from normal menstrual patterns in terms of frequency, regularity, duration, or volume, AUB encompasses a wide spectrum of conditions ranging from hormonal imbalances to serious structural pathologies such as fibroids and malignancies. Despite its common occurrence, awareness about AUB remains alarmingly low, often leading to delays in seeking medical care, misinterpretation of symptoms and increased risk of complications including anemia, infertility and impaired quality of life [1-4].

In India, societal stigma surrounding menstruation, cultural taboos and widespread myths contribute further to the   normalization   of    abnormal   bleeding    patterns.   Many women perceive irregular, heavy, or prolonged bleeding as a benign variation rather than a potential warning sign requiring professional evaluation. Particularly in metropolitan settings like Delhi, where access to healthcare is comparatively better, the persistence of misconceptions and the reluctance to seek timely medical intervention underscore deep-rooted gaps in menstrual health literacy [5,6].

Understanding the level of awareness, identifying prevailing myths and recognizing barriers to healthcare-seeking behavior are essential to designing effective educational interventions and improving gynecological outcomes. While global and regional studies have highlighted the burden of AUB, focused research assessing the knowledge, perceptions and misconceptions among urban Indian women remains limited [6-8].

This study aims to evaluate awareness regarding abnormal uterine bleeding among women of reproductive age in Delhi, exploring their understanding of menstrual irregularities, determining the threshold at which they seek medical assistance and disentangling the myths from evidence-based facts. By doing so, the research seeks to inform targeted public health strategies that promote menstrual health literacy, empower women to seek timely care and ultimately reduce the burden of untreated gynecological disorders.

Study Design

A descriptive, cross-sectional online survey was conducted to assess awareness, perceptions and misconceptions regarding Abnormal Uterine Bleeding (AUB) among women of reproductive age in Delhi.

Study Area and Population

The study targeted women residing in Delhi, aged between 18 and 45 years, who were capable of reading and understanding Hindi or English. The focus was on reaching a broad demographic through online platforms to capture diverse perspectives across educational and socioeconomic backgrounds.

Study Duration

Data collection was carried out over a three-month period, from January to March 2025.

Sample Size and Sampling Technique

Using a 95% confidence interval, a 5% margin of error and an assumed 50% prevalence of awareness regarding AUB, the minimum sample size was calculated to be 384. To accommodate potential incomplete responses, a final target sample of 400 participants was set.

Participants were recruited using a convenience sampling technique. The survey link was disseminated through widely used digital channels such as WhatsApp groups, Facebook communities, Instagram and local women's forums in Delhi to ensure maximum reach and diversity.

Inclusion and Exclusion Criteria

Inclusion Criteria

• Women aged 18-45 years

• Current residents of Delhi

• Ability to comprehend Hindi or English

• Access to a smartphone, computer, or tablet with internet connectivity

• Willingness to provide informed digital consent

Exclusion Criteria

• Pregnant women or those within six months postpartum

• Women with diagnosed hematological or coagulation disorders

• Participants unwilling or unable to provide informed consent

Data Collection Instrument

A structured, pre-validated questionnaire was developed and hosted on Google Forms. The questionnaire was designed in both Hindi and English to ensure accessibility. It comprised four key sections:

• Socio-Demographic Information: Age, marital status, education, occupation and healthcare access

• Menstrual and Medical History: Cycle regularity, menstrual flow characteristics, past diagnoses of AUB or other gynecological conditions

• Knowledge and Awareness Assessment: 20 multiple-choice questions assessing participants’ knowledge about AUB, symptoms warranting medical attention and preventive health behavior

• Myths vs. Facts Identification: Statements reflecting common misconceptions about menstrual health, requiring participants to identify them as true or false

Prior to deployment, the questionnaire was pilot-tested with 30 participants to ensure clarity and cultural sensitivity. Feedback was used to finalize the instrument.

Data Collection Procedure

Participants accessed the Google Form via an online link. A detailed introductory page explained the study purpose, ensured voluntary participation, guaranteed anonymity and included an electronic consent checkbox, which participants had to select before proceeding.

Duplicate responses were avoided by configuring Google Forms to accept only one submission per user email account, without collecting personal identifiers to maintain confidentiality.

Scoring and Data Categorization

Each correct response in the knowledge section was awarded one point. Cumulative knowledge scores were categorized as follows:

• Very Good: ≥80% correct answers

• Good: 60%-79% correct answers

• Fair: 40%-59% correct answers

• Poor: <40% correct answers

Responses to the myths vs. facts section were separately analyzed to assess the prevalence of common misconceptions.

Data Analysis

Data from Google Forms were exported to Microsoft Excel and analyzed using IBM SPSS version 26.0. Descriptive statistics (means, frequencies, percentages) summarized demographic data and awareness levels. 

Ethical Considerations

Participation was entirely voluntary, with informed electronic consent obtained before starting the questionnaire. Anonymity and confidentiality were strictly maintained throughout data collection, storage and analysis.

The socio-demographic profile of the 400 participants revealed that the majority were between 26-35 years of age (41.8%), followed by 36-45 years (29.8%) and 18-25 years (28.3%). Regarding marital status, most participants were married (55.8%), while 38.0% were single and 6.3% were divorced or widowed. Educational attainment showed a relatively high level, with 35.8% holding an undergraduate degree and 34.3% having completed secondary school, while only 4.3% reported no formal education. Occupationally, homemakers represented the largest group (31.5%), followed by private sector employees (24.3%), self-employed individuals (17.3%), students or unemployed women (14.8%) and government  employees (12.3%).  In  terms of   healthcare  access,   a   significant   proportion  (68.5%) 
reported regular access to healthcare facilities, whereas 31.5% had limited access, indicating a potential barrier to timely gynecological consultations for some women (Table 1).

Awareness and knowledge regarding Abnormal Uterine Bleeding (AUB) among participants showed encouraging results, with consistently high percentages of correct responses across most questions. A strong majority (82.3%) correctly defined AUB as irregular or excessive bleeding and 78.0% recognized hormonal imbalance as a potential cause. Most participants (84.0%) understood that heavy menstrual bleeding warrants medical consultation and 85.8% agreed that a gynecologist should evaluate AUB. However, knowledge gaps were noted; only 63.3% identified AUB as a potential sign of endometrial cancer and 66.5% acknowledged its possible impact on fertility. The role of stress, lifestyle modifications and oral contraceptives in AUB was moderately well recognized, with correct responses ranging from 70% to 75%. Encouragingly, 86.8% correctly identified that a gynecologist should diagnose AUB, highlighting a generally good level of awareness about the need for professional intervention (Table 2).

The overall knowledge scores demonstrated that a substantial proportion of participants had a good understanding of AUB. Specifically, 42.3% achieved a "Good" knowledge score (60%-79%), while 32.8% attained a "Very Good" score (≥80%), collectively indicating that over 75% of participants had commendable awareness. However, 19.8% of respondents fell into the "Fair" category (40%-59%) and 5.3% exhibited "Poor" knowledge (<40%), suggesting that while the general level of awareness was satisfactory, a notable minority still harbored significant knowledge deficits. These findings emphasize the need for targeted educational initiatives to address the gaps in understanding, particularly among those with fair or poor awareness levels (Table 3).

Table 1: Socio-demographic characteristics of participants

Table 2: Awareness and knowledge of Abnormal Uterine Bleeding (AUB) among participants

Table 3: Knowledge Score Classification

The present study provides crucial insights into the awareness, knowledge and misconceptions related to Abnormal Uterine Bleeding (AUB) among women of reproductive age in Delhi. Given the significant impact of AUB on women's health, productivity and quality of life, evaluating public understanding is essential for devising effective strategies to promote early diagnosis and timely management. Our findings reveal that although a commendable proportion of participants demonstrated good to very good knowledge levels, critical gaps persist, particularly concerning the recognition of severe symptoms and the potential long-term consequences of untreated AUB.

The demographic profile of the participants showed a majority in the economically active age group of 26-35 years (41.8%), reflecting a population that is likely to experience heightened awareness due to higher exposure to healthcare information via digital media, employment-related health benefits and educational attainment. Encouragingly, most respondents held at least a secondary school education, with a significant proportion having undergraduate (35.8%) and postgraduate (13.0%) degrees, which correlates with relatively high baseline knowledge scores observed in this study.

Awareness regarding basic definitions and symptoms of AUB was satisfactory among participants. Over 82% correctly identified AUB as irregular or excessive bleeding and 84% acknowledged that heavy menstrual bleeding warrants medical attention. Furthermore, 85.8% correctly recognized that AUB should be evaluated by a gynecologist, reflecting a positive healthcare-seeking attitude. These findings align with previous studies suggesting that educational attainment and urban living contribute to greater health awareness among women [6,7].

However, despite these strengths, certain misconceptions and knowledge deficits were evident. Only 63.3% recognized AUB as a potential early sign of endometrial cancer—a finding that raises concern given the importance of early cancer detection. Similarly, only 66.5% understood the possible impact of AUB on fertility, which could lead to delays in seeking reproductive counseling or treatment. Knowledge about lifestyle-related contributors such as stress and the role of oral contraceptives in influencing bleeding patterns was moderate (around 70-75%), indicating that while general awareness exists, a more nuanced understanding of risk factors remains limited.

The analysis of knowledge score distribution further highlights the gaps: although 75.1% of women exhibited either good or very good knowledge, nearly one-quarter (25.1%) demonstrated only fair or poor understanding. This subgroup represents a critical target for intervention, particularly as knowledge gaps may result in normalization of abnormal symptoms, delayed healthcare access, self-treatment, or reliance on unproven home remedies. It is noteworthy that even among women with regular access to healthcare (68.5% of participants), misconceptions persisted, suggesting that mere access to services is insufficient without parallel efforts in health education and patient empowerment.

Sociocultural factors such as menstrual stigma, myths and embarrassment surrounding discussions of reproductive health may also contribute significantly to underreporting and delays in seeking medical care. These barriers have been well-documented in Indian settings and are compounded by societal taboos that discourage open conversations about menstrual irregularities [9,10].  Our study reinforces the need for culturally sensitive educational interventions that not only convey medical facts but also challenge deeply rooted myths and normalize help-seeking behavior.

The findings also underscore the critical role of digital platforms in disseminating health information. Given that this study was conducted online, it highlights the potential of digital health campaigns in reaching a broad audience effectively. Leveraging social media, mobile health applications and online awareness drives can be instrumental in bridging the knowledge gaps identified, particularly among younger, tech-savvy populations.

Nevertheless, several limitations should be acknowledged. The convenience sampling method and reliance on online data collection may have introduced selection bias, favoring women with better digital access, literacy and interest in health topics. As a result, the findings may not be fully generalizable to women from lower socioeconomic strata or those with limited internet access. Future research should consider mixed-method approaches, including in-person surveys, to ensure more inclusive representation.

In conclusion, while the general awareness of AUB among women in Delhi appears satisfactory, significant gaps persist in understanding critical symptoms, risk factors and complications. To enhance menstrual health literacy, comprehensive public health strategies are required, encompassing community education programs, school-based menstrual health curriculums and proactive gynecological counseling initiatives. Empowering women with knowledge and breaking the silence around menstrual health issues are vital steps toward improving timely diagnosis, reducing complications and promoting the overall well-being of women in urban India.

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